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Organization
THE SALVATION ARMY
Active
Organization
THE SALVATION ARMY
Active
Other names
The Salvation Army - Dental Center of Johnstown
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL JOHN SOUTHWICK (SECRETARY)
(845) 620-7329
Entity
Organization
Contact information
Practice address
647 MAIN STREET, PO BOX 968, JOHNSTOWN, PA 15907-0968
(814) 539-3110
(814) 536-4785
Mailing address
440 W NYACK RD, WEST NYACK, NY 10994-1753
(845) 620-7200
(845) 620-7615
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS025867L
PA
251V00000X
Voluntary or Charitable Agency
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011051320005
—
PA
Enumeration date
09/04/2013
Last updated
07/21/2022
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